内镜视野下腰椎关节滑囊解剖与年龄相关性分析

Correlation Analysis of Lumbar Joint Bursae Anatomy and Age Under Endoscopic View

目的 分析后入路脊柱内镜手术中观察到的下腰椎椎间小关节滑囊形态、分型及与年龄的相关性。方法 回顾性分析2020年12月至2021年12月在河南省直第三人民医院实施后入路脊柱内镜手术的32例患者,常规内镜透视下置管,对于椎板间隙较小或髓核脱垂的病例,应用镜下环锯术开窗后观察关节滑囊结构。根据术中解剖及组织分离情况,对镜下的滑囊结构进行辨认,并根据形态对滑囊组织进行形态分型。术中对部分疝出冗余滑膜切取病理检查分析,同时分析滑囊的形态与患者的年龄之间的相关性。结果 根据镜下形态可将滑囊分为A扁平型、B饱满型、C薄窄型。其中20~40岁患者6例,占20%,主要为饱满型;40~60岁患者16例,占50%,主要为扁平型,60岁以上患者10例,占30%,主要为薄窄型。腰椎滑膜组织病理结果回示:玻璃样变增生纤维组织及脂肪组织,小血管增生、扩张。Spearman相关性分析结果显示,滑囊的形态与患者年龄存在一定的相关性。结论 腰椎椎间小关节滑囊位置恒定,位于关节腔基底部,深层和浅层黄韧带参与封闭结构;根据观察形态可分为三类,且滑囊形态与年龄密切相关。

Objective To analyze the shape,types in lumbar intervertebral facet joint synovial bursa observed during posterior spinal endoscopic surgery,and its correlation with age.Methods A retrospective analysis was performed on 32 patients undergoing posterior approach spinal endoscopic surgery in Henan Provincial Third People’s Hospital from December 2020 to December 2021.The placement of cather was under conventional endoscopic fluoroscopy.For cases with small intervertebral space or prolapse of nucleus pulposus,the joint synovial structure was observed after fenestration during endoscopic circular sawing surgery.According to the intraoperative anatomy and tissue separation,the structure of the bursa under the microscope was identified and the bursa were classified according to the morphology.The pathological examination of partial herniated redundant synovium was analyzed during the operation,and the correlation between the morphology of the bursae and the age of the patient was analyzed.Results According to the microscopic morphology,synovial bursa can be divided into A flat type,B full type,C thin and narrow type.6 patients aged 20-40 years,accounted for 20%,mainly was full type.16 patients aged 40-60 years,accounted for 50%,mainly was flat type.10 patients aged over 60 years old,accounted for 30%,mainly was thin and narrow type.Pathological results of lumbar synovium showed hyalinous hyperplasia of fibrous tissue and adipose tissue,hyperplasia and dilation of small vessels.Spearman correlation analysis showed that the morphology of bursae was correlated with the age of patients.Conclusion Lumbar intervertebral facet joint bursa position is constant,according to the observed morphology they can be divided into three categories,and the shape of the bursa is correlated with age.